Water, sanitation and health: South Africa's remaining and existing issues.

Post-apartheid South Africa can lay claim to having substantially increased access to piped drinking water for all. Virtually all urban households and most rural households now have access to piped drinking water, with the remaining deprived communities located in more remote rural areas and in urban informal settlements. While drinking water may not necessarily be safe (or consistently available) in rural communities, there has been no recurrence of waterborne epidemics on the scale of the cholera epidemic of 2000–2001. However, child under-five diarrhoea case fatality rates indicate ongoing health issues in rural communities deprived of water services.

Water-related health issues are emerging due to conditions of water stress and climate change. Constraints on supply call for greater water re-use and better management of treatment plants to ensure river health and safe drinking water. The process of eutrophication is degrading water and habitat quality, and the results are difficult to treat. With climate change, existing microbial diseases could become more prevalent which is especially disturbing as water treatment plants are discharging insufficiently treated effluent into rivers. Contamination of groundwater and surface water from acid mine drainage requires specialised treatment. All of these factors indicate the need for improved water and health management, with greater surveillance of water quality and the delivery of universal water services to ensure health and prevent disease outbreaks.

The water-related Sustainable Development Goals extend the range of commitment beyond access to basic water services, and include improved water quality, enhanced water use and re-use and better water-related ecosystems. These commitments will demand a well-integrated approach and close public monitoring.